Dietary Approaches for Stroke Prevention
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Stroke is a leading cause of mortality and long-term disability. The consequences of stroke are often devastating and irreversible. Many stroke survivors experience mental and physical impairment and require assistance with daily life activities. Prevention of stroke through modifiable risk factors, such as diet, is, therefore, crucial to public health. Diet may influence stroke development through multiple pathways and mechanisms, including effects on blood pressure, blood lipids, thrombosis and coagulation, oxidative stress, systemic inflammation, endothelial function, glucose and insulin homeostasis, gut microbiome, and body weight. This review summarizes available data from prospective studies and randomized controlled trials (RCTs) of the associations of dietary patterns, foods, beverages, selected nutrients, and bioactive compounds with stroke risk.
The DASH diets (Mediterranean and Dietary Approaches to Stop Hypertension) are the most well-studied dietary patterns. The traditional Mediterranean diet is characterized by high amounts of olive oil, nuts, fruits, vegetables, and cereals; moderate amounts of fish and poultry; low consumption of dairy products, red and processed meats, and sweets; and wine in moderation.1 Such diet is high in fiber, vitamins, minerals, phenolics, and unsaturated fatty acids and low in sodium and saturated and trans fatty acids. Results from a meta-analysis of 13 observational studies and 1 RCT showed that a high adherence to a Mediterranean-style diet pattern was associated with a ≈30% reduced risk of stroke (relative risk [RR], 0.68; 95% confidence interval [CI], 0.58–0.79).2 The meta-analysis included results from the PREDIMED trial (Prevención con Dieta Mediterránea), which was the first large RCT to examine whether cardiovascular disease events could be reduced by a Mediterranean diet.1 In the PREDIMED trial, 7447 Spanish adults at high risk of cardiovascular disease were randomly assigned to 1 of 3 diets: a Mediterranean diet supplemented with extravirgin olive oil, a Mediterranean diet supplemented with mixed nuts …